Zambia Malaria and Yellow Fever

[MikeAG]

With Larium, the treatment of malaria can be difficult due to the interaction with Quinine causing potential severe heart arrhythmias. Stan.

Great stuff Stan. That is an excellent summation of the current state of play, as far as I understand it.

A minor point regarding your comment about Larium and its interaction with quinine.......well, no-one uses quinine any more. Typically, Coartem is used to treat malaria now, and doesn't, apparently, have this problem with Larium.

I always carry coartem, because despite the prophylaxis being pretty good (about 90-95% efficacy, I read), and despite taking good precautions against being bitten, it is still possible to catch malaria.

Those living in malarial areas would tend to treat any illness or even lethargy with coartem, on the assumption that they have the early stages of malaria. This is sound practice for anyone travelling in a malarial area who feels ill.

Mike

[Stan Weakley]

Yes Mike I always carry Coartem, now widely available in SA, obtainable at most travel clinics here (together with malaria test kits). Anyone buying these please make sure the doctor explains its safe usage, side effects and watch the expiry dates. There are inherent dangers attached to self-medication. I am not up to scratch with the test kits and their reliability.

Unfortunately Mike, very ill patients in the Intensive Care Unit, with cerebral malaria, kidney or multiple organ failure still often require intravenous Quinine type medications as Coartem only comes in an oral formulation. These critically ill patients cannot absorb oral formulations effectively. Sorry, a bit technical, hopefully none of us will ever reach this stage. Read this thread about an unfortunate members son. http://www.4x4community.co.za/forum/...hlight=malaria

Stan.

[MikeAG]

OK, I stand corrected. Thanks Stan.

[Gary110]

Just another point, Malanil is also now available in a "junior" doseage pack...

The malaria rapid test kits are pretty accurate, but some only test for Falciparum. Try to get a multi-strain test kit. They sometimes show a false-negative (test shows negative when you actually do have the disease) in the early stages of malaria, but if they show positive then you can be assured you have malaria.

I also concur with Tony Weaver, if you will be in a malaria area for more than 7 days, take a couple of boxes of Coartem with you. Rather safe than sorry.

[dieselfan]

So what do the rangers and people that live in these high risk areas take - full time? My sister her friends, hubby etc have stayed in these areas for many years not taking the big word thingies. Is it safe to take them for so long? What's the advice to them?

My BIL does have recurring malaria as a result but a small stat amongst many. It is not an opinion it's what I've observed.

If mem serves right they were told to take a Garlic type pill daily. When my BIL stopped taking it for a few months he caught Malaria.

[Gary110]

People who live in a Malaria area do build up a tolerance to the Malaria. They never get immune though. They can, and still do get Malaria.

The garlic pills cause an odour released by the skin that the mozzies may or may not find replusive.

[Thirstie]

Gary, a little birdy (aka Johnny Velloza from BHP) told me you are going to DRC? When do you leave? Coming for a visit before that? I am sulking as I was hoping you would be able to come and do level 2 First Aid training for my guides. Johnny was trying to set it up.

On a scale of 1 to 10 where would you put Zambia as a malaria risk compared to other sub Sahara African countries?

[mfuwefarmer]

Please take note that poeple are now being refused entry into Zambia if they do not have a valid yellow fever certificate.

[Gary110]

Hi Linda,

PM sent...

As Zambia is a pretty wet country, most of the time, the incidence of malaria is pretty high. I did encounter much higher levels in the western DRC when I worked there in 2009, even in their dry season, but we were in close proximity to the Congo river. Personally I would not rate Zambia very high on the scale, as you guys have pretty good medical facilities, even in the smaller villages. So people do get malaria a lot, but they also get good treatment. Unlike some areas of the DRC where medical help is often a weeks walk away...

So for the incidence of the disease occuring I would probably give it a 8/10, but for the disease being fatal, only a 1/100. (by this i would imply that without any protection, chemical or physical, 8 out of 10 people will contract malaria at some stage in Zambia, but perhaps only 1 in a 100 of those may die from it.) These are only my personal opinions and observations, and not those of any company or group that I am associated with!!

[Thirstie]

Thanks Gary. Got your PM. Be sure to stay in touch.

From a hospitality perspective the word on the street is that there is a major panic with regards the Yellow Fever Vaccination changes. I received this info:

"I have spoken to Dr Mukonka who is the Director of Public Health

He is very aware of the problem and he has written to WHO in Geneva to point out to them that Zambia is not in the Yellow Fever Belt and as such we should not be included on this list.

It is only the DG of WHO who is able to advise the South Africans to remove us from that list

According to Dr Mulonka, there is no yellow fever in Zambia and there never has been. In fact it was Dr Mukonka who dealt with this problem some 12 years ago when the same thing happened

Please advise our members that this matter is being taken care of."

I know the political wheels turn very slowly but please keep an eye on this sticky for any changes. I will post them immediately. Mark O'Donnell from the Protea Group is driving this and I am confident he will be successful pretty quickly.

[TheWall]

Hi, Apparently mefliam is the generic version of Malarone...
i am a bit scared to try it... Has anyone used Mefliam

[Spook]

Hi, Apparently mefliam is the generic version of Malarone...
i am a bit scared to try it... Has anyone used Mefliam

We have been using Mefliam ever since we started our overlanding trips. The reason why I prefer it, lies in the fact that you only take one pill once a week. I hate pills and the lesser I have to drink, the better.

[TheWall]

We have been using Mefliam ever since we started our overlanding trips. The reason why I prefer it, lies in the fact that you only take one pill once a week. I hate pills and the lesser I have to drink, the better.

Once a week.. So then it is not a generic version of Malarone? Malarone you take 2 days before and 7 days after daily as far as i can understand...

[Spook]

Once a week.. So then it is not a generic version of Malarone? Malarone you take 2 days before and 7 days after daily as far as i can understand...

I don't know about the generic thing. All I've been told, is that mefliam is second best to Malarone and not near as expensive!!

[MikeAG]

Mefliam is mefloquine, also known as Larium (or lariam). It is NOT the generic version of malarone/ malanil.

Larium is the one I usually use, but is the drug that has possible side-effects. One of the reasons to start it a couple of weeks before you travel is that you still have time to swap to another drug if you do notice side effects.

Mike

[TheWall]

Ah, ok. Want to stay away from Lariam... Will rather pay the little extra for Malarone.
Thanks

[IanG]

I've always checked medicines on MIMS. Doctors in SA subscribe to MIMS, so I assume that it is accurate.

http://www.mims.com/India/patientmed...tab/Mefloquine

[Spook]

Ah, ok. Want to stay away from Lariam... Will rather pay the little extra for Malarone.
Thanks

Me thinks it's a Lot more extra Maybe get a quote first!!

[TheWall]

Malarone is going to be R736 @ R23/tablet
Larium is about R250.

[Tony Weaver]

<p>[QUOTE=TheWall;809830]Hi, Apparently mefliam is the generic version of Malarone...</p>
<p>i am a bit scared to try it... Has anyone used Mefliam[/QUOTE

I've been using Lariam, aka Mefloquine aka Mefliam for 20 years. Doesn't affect me at all, but it makes my wife edgy, so she uses doxycycline. As Mike said, if you've never taken it before, take it a week early and see if you react. You can also snap it in half and take half on say, a Monday, and half on Thursday or Friday - just make sure you get it into your bloodstream a week before getting chowed by mozzies.